Rol de conocimientos previos en los resultados de un programa de entrenamiento en sutura de heridas para estudiantes de medicina mediante metodología EPROBA / Role of previous knowledge in the results of a training program in wound suturing for medical students using EPROBA methodology

Resumen Objetivo: Comparar la adquisición de habilidades quirúrgicas básicas en estudiantes de medicina según el tipo de instrucción teórico-práctica recibida previo a un taller estandarizado de sutura de heridas. Materiales y Método: Estudio cuasiexperimental antes-después para estudiantes de cuarto año durante el 2018. Se realizó taller de sutura de heridas aplicado en modelo biológico (pata de cerdo), previo consentimiento informado y aprobación Comité Ético Científico. Mediante instrumento "The Objective Structured Assessment Of Technical Skills" (OSATS) se evaluó técnica de sutura antes y después del entrenamiento. Se dividió a los participantes según conocimientos previos al taller: Grupo A: recibió instrucción teórico-práctica en pacientes in vivo. Grupo B: recibió instrucción teórico-práctica en modelos de simulación. Grupo C: sin conocimientos previos en suturas. Se evaluó percepción de estudiantes mediante encuesta validada. Se comparó puntaje OSATS antes-después del taller y encuesta de percepción según grupo, utilizando SPSS24® y ANOVA. Se consideró significativo p < 0,05. Resultados: Se evaluaron 124 estudiantes. Grupo A: 17 (13,7%); Grupo B: 38 (30,7%); Grupo C: 69 (55,6%) respectivamente. Existió diferencia en puntaje OSATS de ingreso al taller Grupo A: 19,4 ± 4,9; Grupo B: 13,7 ± 6,3; Grupo C: 11,1 ± 4,5 (p < 0,05). Puntaje OSATS finalizada la intervención Grupo A: 28,8 ± 1,5; Grupo B: 28,0 ± 1,9; Grupo C: 27,9 ± 2,2 (p = 0,48), sin diferencia significativa. La intervención fue bien percibida, sin diferencias significativas entre grupos. Discusión: El resultado de evaluación OSATS finalizado el taller es independiente de experiencias, instrucción teórico-práctica o conocimientos previos a la intervención. Conclusión: Los programas de entrenamiento con evaluación estandarizada pueden equiparar los resultados entre estudiantes con diferentes conocimientos previos.

Aim: To compare the learning of basic surgical skills among medical students according to the type of theoretical and practical instruction they had prior to a standardized wound suturing workshop. Materials and Method: Quasi-experimental before and after study intended to fourth year students for the 2018. The wound suturing workshop was carried out with help of a biological model (pork leg), prior to an informed consent and the approval of the Ethics Committee. The suturing skills were evaluated by the tool "The Objective Structured Assessment Of Technical Skills" (OSATS) before and after the training. All of the participating students were sorted in groups by their previous surgical knowledge: Group A: received theoretical and practical instruction in patients. Group B: received theoretical and practical instruction in simulation models. Group C: without previous suturing knowledge. The students perception was evaluated by a validated survey. The OSATS score before and after the workshop and the perception survey were compared between the groups, using SPSS24® and ANOVA. p < 0,05 was considered significant. Results: 124 students were evaluated. Group A: 17 (13.7%); Group B: 38 (30.7%); Group C: 69 (55.6%) accordingly. There was a OSATS score difference before the workshop Group A: 19.4 ± 4,9; Group B: 13.7 ± 6.3; Group C: 11.1 ± 4.5 (p < 0.05). OSATS score after the intervention Group A: 28.8 ± 1.5; Group B: 28.0 ± 1.9; Group C: 27.9 ± 2.2 (p = 0.48), without a significant difference. The intervention was well perceived, without significant differences among the groups. Discussion: The OSATS score post workshop is independent of experiences, theoretical and practical instruction or previous knowledge. Conclusion: Training programs with standardized evaluation can even out the results among students with different previous knowledge.

Entrenamiento de competencias procedimentales quirúrgicas básicas en estudiantes de Medicina mediante un modelo de simulación (EPROBA) / Training of basic surgical procedural skills in medical students using a simulation model (EPROBA)

Resumen Introducción: Los modelos de simulación otorgan entornos controlados para la práctica y la retroalimentación por parte de un tutor. Frente a una primera experiencia, nuestro grupo implementó un modelo simplificado y reproducible para el entrenamiento de habilidades quirúrgicas básicas. Objetivo: Comunicar los resultados de un taller de entrenamiento basado en simulación para la adquisición de habilidades quirúrgicas básicas en estudiantes de Medicina. Materiales y Método: Estudio cuasiexperimental, antes y después, 124 estudiantes de medicina de cuarto año fueron entrenados con la metodología EPROBA (Entrenamiento Procedimental Básico), previo consentimiento informado. Mediante el instrumento "The Objective StructuredAssessment Of Technical Skills" (OSATS) se evaluó la técnica de sutura previo y posterior a la intervención. Se evaluó la percepción de los estudiantes mediante una encuesta validada. Para el análisis estadístico se utilizó SPSS24® y se usó la prueba Mann Whitney para variables no paramétricas considerando significativo p < 0,05. Resultados: El grupo muestra un progreso promedio significativo en su desempeño procedimental. En la Lista de Comprobación OSATS muestra un progreso desde 4,1 puntos a 8,9 (p < 0,001). En la Escala Global OSATS muestra un puntaje basal de 13,0 puntos, aumentando a 28,0 puntos (p < 0,001). La intervención fue bien percibida, obteniendo un puntaje total promedio de 65,4 puntos de 68 máximos. Conclusión: En nuestra experiencia, un modelo simplificado demostró ser eficaz para el entrenamiento en habilidades procedimentales simples como suturas. Múltiples instancias de práctica deben ser otorgadas por las Facultades de Medicina para la retención y mejora de estas habilidades.

Background: Simulation models provide controlled environments for the practice and tutor feedback. Faced with a first experience, our group implemented a simplified and reproducible model for the training of basic surgical skills. Aim: Communicate the results of a training workshop based on simulation for the basic surgical skills training in medical students. Materials and Method: Quasi-experimental study, before and after, 124 fourth year medical students were trained with "EPROBA" methodology, with prior informed consent. Through the instrument "The Objective Structured Assessment of Technical Skills" (OSATS) the technique of suture before and after the intervention was evaluated. The perception of the students was evaluated through a validated survey. For statistical analysis SPSS24® was used and the Mann Whitney test was used for nonparametric variables, it was considered significant p < 0.05. Results: The group shows a significant average progress in its procedural performance. In the OSATS Checklist they show a progress from 4.1 points to 8.9 after the intervention (p < 0.001). In the OSATS Global Scale they show a baseline score of 13.0 points, rising to 28.0 points (p < 0.001). The intervention was well perceived, obtaining a total average score of 65.4 points of 68 maximums. Conclusión: In our experience, a simplified model proved to be effective for training in simple procedural skills such as sutures. Multiple instances of practice must be granted by the Faculties of Medicine for the retention and improvement of these skills.

Retención de competencias procedimentales en estudiantes de medicina posterior a un entrenamiento mediante un modelo de simulación (EPROBA)

Background: Boot camps are used to acquire skills in simple surgical procedures, such as sutures, in a short period of time. Aim: To assess the retention of the procedural skills of medical students who participated in a simulation-based suture workshop. Material and Methods: One hundred five medical students were trained using the EPROBA methodology (Entrenamiento PROcedimental BAsico), with prior informed consent. The instrument "Objective Structured Assessment Of Technical Skills" (OSATS) was applied prior to and after the workshop, and during retention module, which was carried out between three and four months after the suture workshop. Participants were classified according to the level of previous knowledge in sutures. Results: The students showed significant improvement in their scores after the workshop (improvement from 12.9 to 28.5 points, p < 0.001). No significant differences were found between scores after the workshop and those obtained in the retention module (28.5 to 28.1 points, respectively, p = 0.235). No difference in scores were observed when retention was evaluated according to previous knowledge levels. Conclusions: Simulation programs are useful for the acquisition of procedural skills which are retained over time.

[Retention of procedural competences in medicine students after training using a simulation model]. / Retención de competencias procedimentales en estudiantes de medicina posterior a un entrenamiento mediante un modelo de simulación (EPROBA).

BACKGROUND: Boot camps are used to acquire skills in simple surgical procedures, such as sutures, in a short period of time. AIM: To assess the retention of the procedural skills of medical students who participated in a simulation-based suture workshop. MATERIAL AND METHODS: One hundred five medical students were trained using the EPROBA methodology (Entrenamiento PROcedimental BAsico), with prior informed consent. The instrument "Objective Structured Assessment Of Technical Skills" (OSATS) was applied prior to and after the workshop, and during retention module, which was carried out between three and four months after the suture workshop. Participants were classified according to the level of previous knowledge in sutures. RESULTS: The students showed significant improvement in their scores after the workshop (improvement from 12.9 to 28.5 points, p < 0.001). No significant differences were found between scores after the workshop and those obtained in the retention module (28.5 to 28.1 points, respectively, p = 0.235). No difference in scores were observed when retention was evaluated according to previous knowledge levels. CONCLUSIONS: Simulation programs are useful for the acquisition of procedural skills which are retained over time.

Tutoría por pares de distinto año académico en la enseñanza de habilidades quirúrgicas básicas en estudiantes de pregrado de medicina / Peer tutoring in the teaching of basic surgical skills in medical undergraduate students

Resumen Objetivo: Nuestro objetivo es comparar la efectividad de la tutoría impartida por pares de 6° versus 14° semestre en la adquisición de habilidades procedimentales básicas en estudiantes de medicina. Materiales y Método: Estudio cuasi-experimental, antes y después. La intervención consta inicialmente de un curso de formación de monitores de sutura (MS) para dos estudiantes de 6° y dos de 14° semestre de medicina. Posteriormente se implementó un taller de sutura tutorizado por MS a 23 estudiantes de 8° semestre de medicina. Se evaluó sutura continua y discontinua mediante el instrumento: "The Objective Structured Assessment Of Technical Skills" (OSATS) y satisfacción mediante encuesta tipo Likert validada por expertos. Se describen y comparan los resultados pre y postintervención y satisfacción de los estudiantes, de acuerdo al semestre cursado del MS. Se aplicó consentimiento informado. Se utilizó SPSS24® para análisis estadístico mediante prueba de Mann Whitney. Se consideró significativo p < 0,05. Resultados: Ambos grupos progresaron significativamente en la escala OSATS, grupo tutorizado por MS de 6° semestre: 18,1 vs 28,1 (p < 0,001) y grupo tutorizado por MS de 14° semestre: 15,5 vs 27,8 (p < 0,001). Los puntajes finales no presentan diferencias significativas. La intervención fue evaluada con 66 de 68 puntos, sin diferencias significativas según el semestre cursado del MS. Conclusión: Nuestra experiencia muestra que es posible utilizar la tutoría por pares entrenados para la enseñanza de habilidades quirúrgicas, independientemente si la tutoría es impartida por pares de cursos inferiores o superiores, logrando un progreso significativo y un desempeño procedimental equivalente, además de una alta satisfacción entre los estudiantes.

Aim: Our objective is to compare the effectiveness of tutoring taught by 6th versus 14th semester peer students in the acquisition of basic procedural skills in medical students. Materials and Method: Quasi experimental study, before and after. The intervention initially consists of a training workshop for suture monitors (SM) for two students of 6th and two students of 14th semester of medicine. Subsequently, a suture workshop taught by SM to 23 fourth-year medical students was implemented. Continuous and discontinuous suture was evaluated using the instrument: "Objective structured evaluation of technical skills" (OSATS) and satisfaction through a survey validated by experts. The results of pre and post intervention and student satisfaction are described and compared, according to the semester attended by the SM. Informed consent was applied. Excel® and SPSS24® were used for statistical analysis by Mann Whitney test. It was considered significant p < 0.05. Results: Both groups progressed significantly on the OSATS scale, group tutored by 6° semester SM: 18.1 vs 28,1 (p < 0.001) and group tutored by 14° semester SM: 15.5 vs 27,8 and (p < 0.001). The final scores did not they present significant differences. The intervention was well evaluated with 66 out of 68 points, without significant differences according to the semester coursed of the SM. Conclusion: Our experience shows that it is possible to use peer tutoring by trained tutors to teach surgical skills, regardless of whether the teaching is given by pairs of lower or higher courses, achieving significant progress and equivalent procedural performance, in addition to high satisfaction among students.

Implementación de taller de monitores de sutura en alumnos de pregrado de medicina / Implementation of suture monitor workshop in undergraduate medical students

INTRODUCCIÓN: Las técnicas de sutura básicas se consideran competencias mínimas de un egresado de medicina y son fundamentales en el ejercicio de la medicina general. Actualmente, los estudiantes de la Universidad de Concepción no poseen una instancia formal para adquirir estas competencias. OBJETIVOS: Evaluar la validez de un programa de formación de alumnos monitores de sutura a través de los resultados obtenidos mediante un método de evaluación estandarizado, realizado en estudiantes de pregrado de medicina de la Universidad de Concepción. METODOLOGÍA: Estudio preexperimental antes y después. Se realizó intervención teórico-práctica para seis estudiantes de medicina de distintos semestres cursados, entre los meses de mayo y julio de 2017. Consistió en tres módulos: clases teóricas, práctica en modelo biológico y módulo en pabellón quirúrgico supervisado por subespecialistas. Se evaluó punto de sutura continuo y discontinuo en modelo biológico mediante la escala "The Objective Structured Assessment Of Technical Skills" (OSATS). Se describen y comparan resultados de la escala OSATS antes y después del curso. Se aplicó consentimiento informado. Se utilizó SPSS® para análisis estadístico mediante prueba de Mann-Whitney para variables no paramétricas. Se consideró significativo p < 0,05. RESULTADOS: Todos los participantes mejoraron puntuación en escala OSATS. Los participantes progresaron significativamente sus resultados en las distintas escalas OSATS (5,2 vs 8,8; p < 0,05 y 16,5 vs 27,2; p < 0,05) al comparar resultados pre vs posintervención respectivamente. DISCUSIÓN: Nuestra experiencia demuestra que es posible crear un taller de formación de MS con muy buenos resultados, para estudiantes de medicina, a través de una capacitación trimodal, con clases teóricas, simulación y práctica in vivo. Además, constituye la base de futuras investigaciones que buscan solucionar la inexistencia de un programa formal de enseñanza de técnicas de sutura a los estudiantes de medicina de nuestra facultad.

INTRODUCTION: Suture techniques are considered the minimum of a medical examination and are fundamental in the practice of medicine. Currently, the students of the Universidad de Concepción do not have a formal instance to acquire these competences. AIM: To evaluate the validity of a training program for Suture Instructor (SI) students through the results obtained through a standardized assessment method, carried out in undergraduate students of medicine at the University of Concepción. METHOD: Preexperimental before and after study. A theoretical-practical intervention was carried out for six medical students of different semesters of the career, between the months of May and July 2017. It consisted of three modules: theoretical classes, practice in biological model and module in surgical pavilion supervised by subspecialists. Continuous and interrupted sutures were evaluated in the biological model using the "The Objective Structured Assessment of Technical Skills" (OSATS) scale. Results of the OSATS scale are described and compared before and after the course. Informed consent was applied. SPSS® was used for statistical analysis by Mann-Whitney test for non-parametric variables. It was considered significant p < 0.05. Results: All participants improved score on OSATS scale. The participants progressed significantly their results in the different OSATS scales (5.2 vs 8.8, p < 0.05 and 16.5 vs 27.2, p < 0.05) when comparing pre vs post intervention results respectively. DISCUSSION: Our experience shows that it is possible to create an SI training workshop with excellent results for medical students, through a three phase training program, with theory classes, simulation and "in vivo" practice. It also constitutes the basis of future research that seeks to solve the lack of a formal program of teaching suture techniques to medical students of our university.

[The educational context to train health care professionals. A qualitative approach]. / Condiciones del contexto educativo para ejercer el rol docente en Ciencias de la Salud. Un enfoque cualitativo.

BACKGROUND: There are differences in the educational context in Health Sciences, between clinical and non-clinical teachers. Therefore, the didactic and reflexive peculiarities of both educational scenarios should be analyzed. AIM: To describe the conditions of the educational context in Health Sciences for the practice of the teaching role in a Chilean university. MATERIAL AND METHODS: Qualitative study, performed according to Grounded Theory of Strauss and Corbin. Thirty one teachers from six health sciences programs were selected according to Patton's maximum variation criterion and contacted personally, after an informed consent process. Semi-structured interviews and focus group were performed, analyzed by open coding, using the constant comparison method, with the Atlas-ti 7.5.2 software. RESULTS: Six conditions of the educational context that can support the teaching role in these careers emerged. Namely, a clinical field suited for patient attention and teaching, classrooms designed for the new educational models, number of students in the classrooms and clinical settings, insertion programs for teachers' training, teachers' coordination and economic resources of the program. CONCLUSIONS: Health Sciences programs are developed in a complex educational context, having to articulate diverse elements to train professionals. Therefore, it is fundamental to understand the conditions of the educational context that can favor the practice of the teaching role, thus generating improvements in teaching-learning process.

Condiciones del contexto educativo para ejercer el rol docente en Ciencias de la Salud: un enfoque cualitativo / The educational context to train health care professionals: a qualitative approach

Background: There are differences in the educational context in Health Sciences, between clinical and non-clinical teachers. Therefore, the didactic and reflexive peculiarities of both educational scenarios should be analyzed. Aim: To describe the conditions of the educational context in Health Sciences for the practice of the teaching role in a Chilean university. Material and Methods: Qualitative study, performed according to Grounded Theory of Strauss and Corbin. Thirty one teachers from six health sciences programs were selected according to Patton's maximum variation criterion and contacted personally, after an informed consent process. Semi-structured interviews and focus group were performed, analyzed by open coding, using the constant comparison method, with the Atlas-ti 7.5.2 software. Results: Six conditions of the educational context that can support the teaching role in these careers emerged. Namely, a clinical field suited for patient attention and teaching, classrooms designed for the new educational models, number of students in the classrooms and clinical settings, insertion programs for teachers' training, teachers' coordination and economic resources of the program. Conclusions: Health Sciences programs are developed in a complex educational context, having to articulate diverse elements to train professionals. Therefore, it is fundamental to understand the conditions of the educational context that can favor the practice of the teaching role, thus generating improvements in teaching-learning process.

Factores que afectan al ambiente educativo en la formación preclínica de medicina según sus docentes / Factors affecting the educational environment in undergraduate medical schools

Background: Educational environment has an important effect on the quality of learning and student satisfaction in medicine. Most of previous studies have been conducted using questionnaires that assess the phenomenon considering overall dimensions, without paying attention to the specific manifestations of this topic, especially those aspects that are related to the protagonists of the learning process: teachers and students. Aim: To describe factors that affect the educational environment in the preclinical Medical formation, according to Medical teachers in Concepción, Chile. Material and Methods: Qualitative study, using the Grounded theory method. Semi-structured interviews were performed to 10 medical teachers in Concepcion, Chile. They were selected by theoretical sampling. Data were analyzed using open coding. Results: Four emerging categories about the factors that affect the learning environment were identified: Personal factors of students, academic factors of students, personal factors of teachers and academic factors of teachers. Conclusions: According to interviewed teachers, both personal factors in teachers and students that promote a positive learning environment are related with an attitude oriented towards others and communication skills. Academic factors are related with the responsible exercise of student and teacher roles and with the promotion of participation in the educational process.

Relación entre prácticas pedagógicas y estrategias de aprendizaje en docentes de carreras de la salud / Teaching practices and learning strategies in health careers

Background: Medical Education, according to the constructivist education paradigm, puts students as the protagonists of the teaching and learning process. It demands changes in the practice of teaching. However, it is unclear whether this new model is coherent with the teachers’ ways to cope with learning. Aim: To analyze the relationship between teaching practices and learning strategies among teachers of health careers in Chilean universities. Material and Methods: The Teaching Practices Questionnaire and Learning Strategies Inventory of Schmeck were applied to 200 teachers aged 24 to 72 years (64% females). Results: Teachers use different types of teaching practices. They commonly use deep and elaborative learning strategies. A multiple regression analysis showed that learning strategies had a 13% predictive value to identify student-centered teaching, but they failed to predict teacher-centered teaching. Conclusions: Teaching practices and learning strategies of teachers are related. Teachers frequently select constructivist model strategies, using different teaching practices in their work.

[Motivation and self-directed learning among medical students]. / Aspectos motivacionales involucrados en el aprendizaje autodirigido en estudiantes de medicina. Un enfoque cualitativo.

BACKGROUND: Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. AIM: To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. MATERIAL AND METHODS: A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. RESULTS: From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. CONCLUSIONS: Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.

Aspectos motivacionales involucrados en el aprendizaje autodirigido en estudiantes de medicina. un enfoque cualitativo / Motivation and self-directed learning among medical students

Background: Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. Aim: To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. Material and Methods: A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. Results: From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. Conclusions: Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.

[Teaching practices and learning strategies in health careers]. / Relación entre prácticas pedagógicas y estrategias de aprendizaje en docentes de carreras de la salud.

BACKGROUND: Medical Education, according to the constructivist education paradigm, puts students as the protagonists of the teaching and learning process. It demands changes in the practice of teaching. However, it is unclear whether this new model is coherent with the teachers’ ways to cope with learning. AIM: To analyze the relationship between teaching practices and learning strategies among teachers of health careers in Chilean universities. MATERIAL AND METHODS: The Teaching Practices Questionnaire and Learning Strategies Inventory of Schmeck were applied to 200 teachers aged 24 to 72 years (64% females). RESULTS: Teachers use different types of teaching practices. They commonly use deep and elaborative learning strategies. A multiple regression analysis showed that learning strategies had a 13% predictive value to identify student-centered teaching, but they failed to predict teacher-centered teaching. CONCLUSIONS: Teaching practices and learning strategies of teachers are related. Teachers frequently select constructivist model strategies, using different teaching practices in their work.

[Factors affecting the educational environment in undergraduate medical schools]. / Factores que afectan al ambiente educativo en la formación preclínica de medicina según sus docentes.

BACKGROUND: Educational environment has an important effect on the quality of learning and student satisfaction in medicine. Most of previous studies have been conducted using questionnaires that assess the phenomenon considering overall dimensions, without paying attention to the specific manifestations of this topic, especially those aspects that are related to the protagonists of the learning process: teachers and students. AIM: To describe factors that affect the educational environment in the preclinical Medical formation, according to Medical teachers in Concepción, Chile. MATERIAL AND METHODS: Qualitative study, using the Grounded theory method. Semi-structured interviews were performed to 10 medical teachers in Concepcion, Chile. They were selected by theoretical sampling. Data were analyzed using open coding. RESULTS: Four emerging categories about the factors that affect the learning environment were identified: Personal factors of students, academic factors of students, personal factors of teachers and academic factors of teachers. CONCLUSIONS: According to interviewed teachers, both personal factors in teachers and students that promote a positive learning environment are related with an attitude oriented towards others and communication skills. Academic factors are related with the responsible exercise of student and teacher roles and with the promotion of participation in the educational process.

[An assessment of the Dundee Ready Education Environment Measure (DREEM) in Chilean university students]. / Estructura factorial de la escala DREEM en estudiantes de medicina chilenos.

BACKGROUND: The entry to a University requires an adaptation process that not all students solve with the same kind of success. Even though students social adaptation and emotional skills are essential, the educational environmental that they perceive has a significant influence in their academic life. AIM: To describe the changes in the perception about academic environment that medical students experience during the first three years of undergraduate career. MATERIAL AND METHODS: The Dundee Ready Education Environment Measure (DREEM) scale was applied to 525 first to third year medical students and an exploratory factorial analysis was made. RESULTS: Four factors were identified: Academic Perception: academic quality that students attribute to the process in which they take part, as well as to the assessment that they do of their learning outcomes (coefficient ± = 0.85); Academic Experience: refers to positive emotions that students experience during the career such as confidence, pleasure and energy (coefficient ± = 0.76); Atmosphere Perception, comfort and calm that students experiment during their academic activities (coefficient ± = 0.79); Teachers Perception: the perception that students have of teachers about their interest and disposition towards students (coefficient ± = 0.50). CONCLUSIONS: The assessment of academic environment quality is inversely associated with the lapse that the students have spent in their undergraduate careers.

[Factors associated with self-directed learning among medical students]. / Predictores afectivos y académicos del aprendizaje autodirigido en estudiantes de medicina.

BACKGROUND: Self-directed learning is a skill that must be taught and evaluated in future physicians. AIM: To analyze the association between self-directed learning, self-esteem, self-efficacy, time management and academic commitment among medical students. MATERIAL AND METHODS: The self-directed learning, Rosemberg self-esteem, general self- efficacy, time management and Utrecht work engagement scales were applied to 297 first year medical students. RESULTS: A multiple regression analysis showed a significant association between self-efficacy, time management and academic commitment with self-directed learning. Self-esteem and satisfaction with studies did not enter in the model. CONCLUSIONS: self-esteem, academic commitment and a good time management were associated with self-directed learning in these students.

Estructura factorial de la escala DREEM en estudiantes de medicina chilenos

Background: The entry to a University requires an adaptation process that not all students solve with the same kind of success. Even though students social adaptation and emotional skills are essential, the educational environmental that they perceive has a significant influence in their academic life. Aim: To describe the changes in the perception about academic environment that medical students experience during the first three years of undergraduate career. Material and Methods: The Dundee Ready Education Environment Measure (DREEM) scale was applied to 525 first to third year medical students and an exploratory factorial analysis was made. Results: Four factors were identified: Academic Perception: academic quality that students attribute to the process in which they take part, as well as to the assessment that they do of their learning outcomes (coefficient ± = 0.85); Academic Experience: refers to positive emotions that students experience during the career such as confidence, pleasure and energy (coefficient ± = 0.76); Atmosphere Perception, comfort and calm that students experiment during their academic activities (coefficient ± = 0.79); Teachers Perception: the perception that students have of teachers about their interest and disposition towards students (coefficient ± = 0.50). Conclusions: The assessment of academic environment quality is inversely associated with the lapse that the students have spent in their undergraduate careers.

Predictores afectivos y académicos del aprendizaje autodirigido en estudiantes de medicina / Factors associated with self-directed learning among medical students

Background: Self-directed learning is a skill that must be taught and evaluated in future physicians. Aim: To analyze the association between self-directed learning, self-esteem, self-efficacy, time management and academic commitment among medical students. Material and methods: The self-directed learning, Rosemberg self-esteem, general self- efficacy, time management and Utrecht work engagement scales were applied to 297 first year medical students. Results: A multiple regression analysis showed a significant association between self-efficacy, time management and academic commitment with self-directed learning. Self-esteem and satisfaction with studies did not enter in the model. Conclusions: self-esteem, academic commitment and a good time management were associated with self-directed learning in these students.

[Learning strategies of autonomous medical students]. / ¿Cómo abordan su aprendizaje los estudiantes de medicina autónomos? Una aproximación cualitativa.

BACKGROUND: Understanding how autonomous students are capable of regulating their own learning process is essential to develop self-directed teaching methods. AIM: To understand how self-directed medical students approach learning in medical schools at University of Concepción, Chile. MATERIAL AND METHODS: A qualitative and descriptive study, performed according to Grounded Theory guidelines, following Strauss & Corbin was performed. Twenty medical students were selected by the maximum variation sampling method. The data collection technique was carried out by a semi-structured thematic interview. Students were interviewed by researchers after an informed consent procedure. Data were analyzed by the open coding method using Atlas-ti 7.5.2 software. RESULTS: Self-directed learners were characterized by being good planners and managing their time correctly. Students performed a diligent selection of contents to study based on reliable literature sources, theoretical relevance and type of evaluation. They also emphasized the discussion of clinical cases, where theoretical contents can be applied. This modality allows them to gain a global view of theoretical contents, to verbalize knowledge and to obtain a learning feedback. CONCLUSIONS: The learning process of autonomous students is intentional and planned.

[Assessment of psychometric properties of the academic involvement questionnaire, expectations version]. / Propiedades psicométricas de un cuestionario para evaluar expectativas académicas en estudiantes de primer año de Medicina.

BACKGROUND: Academic Involvement Questionnaire, Expectations version (CIA-A), assesses the expectations of involvement in studies. It is a relevant predictor of student success. However, the evidence of its validity and reliability in Chile is low, and in the case of Medical students, there is no evidence at all. AIM: To evaluate the factorial structure and internal consistency of the CIA-A in Chilean Medical school freshmen. MATERIAL AND METHODS: The survey was applied to 340 Medicine freshmen, chosen by non-probability quota sampling. They answered a back-translated version of CIA-A from Portuguese to Spanish, plus a sociodemographic questionnaire. For psychometric analysis of the CIA-A, an exploratory factor analysis was carried on, the reliability of the factors was calculated, a descriptive analysis was conducted and their correlation was assessed. RESULTS: Five factors were identified: vocational, institutional and social involvement, use of resources and student participation. Their reliabilities ranged between Cronbach's alpha values of 0.71 to 0.87. Factors also showed statistically significant correlations between each other. CONCLUSIONS: Identified factor structure is theoretically consistent with the structure of original version. It just disagrees in one factor. In addition, the factors' internal consistency were adequate for using them in research. This supports the construct validity and reliability of the CIA-A to assess involvement expectations in medical school freshmen.